Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 61: A 32-year-old woman is diagnosed with major depression. What is the chance that her identical twin sister will develop the same disease?

A. 5%
B. 20%
C. 50%
D. 70% (Correct Answer)

Explanation: ### Explanation **1. Understanding the Correct Answer (D: 70%)** The question tests the concept of **concordance rates** in psychiatric genetics. Concordance refers to the probability that if one twin has a disorder, the other will also develop it. For Major Depressive Disorder (MDD), studies on Monozygotic (identical) twins—who share 100% of their genetic material—show a concordance rate of approximately **50% to 70%**. This high percentage highlights a significant genetic predisposition, although environmental factors also play a role. **2. Analysis of Incorrect Options** * **Option A (5%):** This is closer to the lifetime prevalence of MDD in the general population (approx. 5-12% for men). * **Option B (20%):** This represents the concordance rate for **Dizygotic (fraternal) twins**, who share only 50% of their genes. It is also the approximate risk for a first-degree relative of a patient with MDD. * **Option C (50%):** While some older studies cite 50%, modern psychiatric literature and NEET-PG patterns frequently use the upper limit (70%) to emphasize the high genetic load in identical twins compared to fraternal twins. **3. NEET-PG Clinical Pearls & High-Yield Facts** * **Bipolar Disorder (BPAD):** Has an even higher genetic link than MDD. Monozygotic twin concordance is **70-90%**, while Dizygotic is **15-25%**. * **Schizophrenia:** Monozygotic twin concordance is approximately **40-50%**. * **General Rule:** If a question asks for twin concordance in major psychiatric illnesses, BPAD > MDD > Schizophrenia. * **First-degree relatives:** The risk for MDD in a first-degree relative of an affected individual is roughly **2 to 3 times** higher than the general population.

Question 62: "Learned helplessness" is typically seen in which of the following conditions?

A. Delirium
B. Dementia
C. Schizophrenia
D. Depression (Correct Answer)

Explanation: **Explanation:** **Correct Answer: D. Depression** The concept of **Learned Helplessness** was proposed by **Martin Seligman** based on animal models (the "shuttle box" experiment with dogs). It describes a state where an individual, after facing repeated uncontrollable stressors, stops attempting to escape or change the situation, even when an opportunity for relief becomes available. In clinical psychiatry, this serves as a cognitive model for **Depression**. It explains the core symptoms of hopelessness, passivity, and a lack of motivation. Patients perceive that they have no control over their environment, leading to the belief that "nothing I do matters," which reinforces the depressive cycle. **Why other options are incorrect:** * **Delirium (A):** This is an acute organic brain syndrome characterized by fluctuating consciousness and impaired attention, not a learned cognitive behavior. * **Dementia (B):** This involves a chronic, global impairment of cognitive functions (memory, executive function). While patients may become passive, it is due to neurodegeneration rather than a learned psychological response. * **Schizophrenia (C):** While "avolition" (lack of motivation) is a negative symptom of schizophrenia, it is linked to dopamine dysregulation in the reward pathways rather than the cognitive framework of learned helplessness. **High-Yield Clinical Pearls for NEET-PG:** * **Attributional Style:** In depression, individuals attribute negative events to **Internal, Stable, and Global** causes (e.g., "It’s my fault, it will always be this way, and it affects everything"). * **Biochemical link:** Learned helplessness is associated with decreased levels of **Norepinephrine** and **Serotonin** in the brain. * **Treatment:** Cognitive Behavioral Therapy (CBT) aims to reverse learned helplessness by challenging these maladaptive thought patterns.

Question 63: According to DSM-IV criteria, what is the minimum duration of depressed mood or loss of interest or pleasure required for the diagnosis of a Major Depressive Episode?

A. 1 week
B. 2 weeks (Correct Answer)
C. 3 weeks
D. 4 weeks

Explanation: **Explanation:** The diagnosis of a **Major Depressive Episode (MDE)** according to DSM-IV (and DSM-5) requires a specific cluster of symptoms to be present for a minimum duration to distinguish clinical depression from transient sadness or "the blues." 1. **Why Option B is Correct:** The diagnostic criteria mandate that at least **five** out of nine symptoms (including either depressed mood or anhedonia) must be present nearly every day for at least **2 consecutive weeks**. This 14-day threshold is the standard clinical benchmark used to ensure the symptoms represent a persistent change from previous functioning. 2. **Why Other Options are Incorrect:** * **Option A (1 week):** This is the duration required for a **Manic Episode**. A single week is considered too short for a definitive diagnosis of MDD. * **Option C (3 weeks):** This duration has no specific diagnostic significance in the classification of mood disorders. * **Option D (4 weeks):** While symptoms often last longer than a month, waiting four weeks would delay necessary clinical intervention. (Note: 4 weeks is the duration required for Post-Traumatic Stress Disorder symptoms). **High-Yield Clinical Pearls for NEET-PG:** * **The "SIGECAPS" Mnemonic:** Sleep, Interest (Anhedonia), Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal ideation. * **Dysthymia (Persistent Depressive Disorder):** Requires a depressed mood for at least **2 years** (1 year in children/adolescents). * **Cyclothymia:** Requires at least **2 years** of hypomanic and depressive periods that do not meet full criteria. * **Post-Stroke Depression:** Most commonly associated with lesions in the **Left frontal cortex**.

Question 64: Which of the following conditions is ECT most useful in?

A. Mania (Acute)
B. Chronic Schizophrenia
C. Acute Depression (Correct Answer)
D. Panic Disorder

Explanation: **Explanation:** Electroconvulsive Therapy (ECT) is a highly effective biological treatment in psychiatry. While it has several indications, **Acute Depression** (specifically Major Depressive Disorder with melancholic or psychotic features) is the condition where ECT shows the highest efficacy and most rapid response. **Why Acute Depression is Correct:** ECT is considered the "gold standard" for treatment-resistant depression or when a rapid clinical response is required (e.g., severe suicidal ideation, refusal to eat, or catatonia). It works by inducing a generalized seizure, which leads to a massive release of neurotransmitters and increases BDNF (Brain-Derived Neurotrophic Factor) levels. **Analysis of Incorrect Options:** * **A. Mania (Acute):** While ECT is effective for acute mania (especially delirious mania), it is typically reserved as a second or third-line treatment after mood stabilizers (Lithium, Valproate) and antipsychotics. * **B. Chronic Schizophrenia:** ECT is generally not effective for the negative symptoms of chronic schizophrenia. It is primarily used in schizophrenia for acute exacerbations, catatonic features, or when there is a strong affective (mood) component. * **C. Panic Disorder:** ECT has no established role in the treatment of anxiety disorders like Panic Disorder. These are managed with SSRIs and Cognitive Behavioral Therapy (CBT). **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** There are **no absolute contraindications** for ECT, but increased intracranial pressure (ICP) is the most significant relative contraindication. * **Most Common Side Effect:** Retrograde amnesia (memory loss) and post-ictal confusion. * **Mortality Rate:** Approximately 0.01 per 1,000 patients (similar to general anesthesia). * **Electrode Placement:** Bilateral (Gold standard for efficacy) vs. Unilateral (Fewer cognitive side effects).

Question 65: Mania is characterized by?

A. Paranoid delusion
B. Loss of orientation
C. High self-esteem
D. Loss of insight (Correct Answer)

Explanation: **Explanation:** In Psychiatry, **insight** refers to a patient’s ability to understand that they have a mental illness, recognize its symptoms, and accept the need for treatment. In **Mania**, the loss of insight is a hallmark feature. Patients typically experience a state of "ego-syntonic" euphoria, believing they are functioning at their peak. This lack of awareness is why manic patients often refuse medication and require involuntary hospitalization. While high self-esteem is a symptom, the **loss of insight** is the defining clinical characteristic that complicates management. **Analysis of Options:** * **A. Paranoid Delusion:** While delusions can occur in "Mania with Psychotic Features," they are more characteristic of Schizophrenia. In mania, delusions are typically **grandiose** (inflated power/knowledge) rather than paranoid. * **B. Loss of Orientation:** Orientation (to time, place, and person) remains **intact** in mood disorders. Disorientation suggests an organic brain syndrome or Delirium. * **C. High Self-esteem:** This is a common symptom (Grandiosity), but it is not as definitive or clinically significant as the loss of insight. A person can have high self-esteem without being manic, but a manic patient almost universally lacks insight into their pathological state. **NEET-PG High-Yield Pearls:** * **DIGFAST** Mnemonic for Mania: **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep (decreased need), **T**alkativeness (pressured speech). * **Insight Scale:** Often measured using the G12 item of the PANSS or the Birchwood Insight Scale. * **Key Distinction:** Hypomania is distinguished from Mania by the *absence* of psychotic features and the fact that it does *not* cause marked impairment in social or occupational functioning.

Question 66: ECT is mainly indicated in:

A. Severe depression (Correct Answer)
B. Schizophrenia
C. Somatization disorder
D. Hysteria

Explanation: **Explanation:** Electroconvulsive Therapy (ECT) is a highly effective biological treatment in psychiatry. While it has several indications, **Severe Depression** (especially Major Depressive Disorder with psychotic features or suicidal ideation) is the primary and most common indication. **Why Severe Depression is Correct:** ECT is considered the "gold standard" for rapid symptom relief in severe depression. It is specifically indicated when: * There is a high risk of suicide (requires immediate intervention). * The patient is stuporous or refusing food/fluids (nutritional compromise). * The depression is resistant to multiple trials of antidepressants. * Psychotic features are present. **Analysis of Incorrect Options:** * **Schizophrenia:** While ECT is used in schizophrenia (specifically catatonic type or acute exacerbations resistant to antipsychotics), it is a second-line treatment. Antipsychotics remain the primary treatment. * **Somatization Disorder:** This is a chronic condition characterized by multiple physical complaints. Treatment focuses on psychotherapy (CBT) and conservative management; ECT has no role here. * **Hysteria (Dissociative/Conversion Disorder):** These are neurotic, stress-related disorders. The mainstay of treatment is psychotherapy and addressing underlying stressors. ECT is not indicated. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Retrograde amnesia (usually resolves) and post-ictal confusion. * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Mechanism:** It works by inducing a generalized tonic-clonic seizure (minimum duration: 25-30 seconds). * **Modified ECT:** Involves the use of an anesthetic (Thiopentone/Propofol) and a muscle relaxant (Succinylcholine) to prevent fractures.

Question 67: Which of the following symptoms must be present for the diagnosis of manic-depressive psychosis?

A. Loss of interest or pleasure (Correct Answer)
B. Recurrent suicidal ideation
C. Indecisiveness
D. Insomnia

Explanation: **Explanation:** The term **Manic-Depressive Psychosis (MDP)**, historically used by Emil Kraepelin, is now synonymous with **Bipolar Disorder**. To diagnose a depressive episode within this spectrum (according to ICD-10/ICD-11 and DSM-5 criteria), certain **core (typical) symptoms** must be present. **Why Option A is Correct:** **Loss of interest or pleasure (Anhedonia)** is one of the two "gateway" symptoms of a Major Depressive Episode. According to diagnostic criteria, at least one of the following must be present: 1. Depressed mood. 2. **Loss of interest or pleasure (Anhedonia).** Without at least one of these core symptoms, a diagnosis of depression cannot be made, regardless of how many other somatic symptoms are present. **Why Other Options are Incorrect:** * **B, C, and D (Suicidal ideation, Indecisiveness, and Insomnia):** These are considered **accessory or secondary symptoms**. While they are common and included in the diagnostic criteria (e.g., SIGECAPS), they are not mandatory for the diagnosis if other criteria are met. A patient can be diagnosed with depression without having suicidal thoughts or insomnia, but they cannot be diagnosed without depressed mood or anhedonia. **High-Yield Clinical Pearls for NEET-PG:** * **Core Triad of Depressive Episode (ICD-10):** Low mood, Anhedonia, and Low energy (Easy fatigability). * **Bipolar I vs. II:** Bipolar I requires at least one **Manic** episode; Bipolar II requires at least one **Hypomanic** episode plus one Major Depressive episode. * **Lithium** remains the gold standard for maintenance treatment in MDP/Bipolar Disorder. * **Nihilistic delusions (Cotard Syndrome)** are most commonly associated with severe psychotic depression.

Question 68: Which of the following is a risk factor for suicide?

A. Initial stages of recovery from depression (Correct Answer)
B. Being on Lithium treatment
C. Being married
D. Being employed

Explanation: **Explanation:** The correct answer is **A. Initial stages of recovery from depression.** **Why it is correct:** Paradoxically, the risk of suicide increases during the initial phase of recovery from a major depressive episode. This occurs because a patient’s **psychomotor retardation** (lack of energy and motivation) often improves before their **depressive mood and hopelessness** lift. During this "window of vulnerability," the patient gains the physical energy and cognitive drive necessary to formulate and carry out a suicide plan, which they previously lacked the energy to execute. **Analysis of Incorrect Options:** * **B. Being on Lithium treatment:** Lithium is one of the few psychiatric medications proven to have a specific **anti-suicidal effect** in patients with Bipolar Disorder and Major Depressive Disorder. * **C. Being married:** Marriage is considered a **protective factor** against suicide. Social support systems and family responsibilities generally decrease the risk, whereas being single, divorced, or widowed increases it. * **D. Being employed:** Employment provides social interaction and financial stability, acting as a **protective factor**. Unemployment is a well-documented risk factor for suicidal ideation and completion. **Clinical Pearls for NEET-PG:** * **Strongest Predictor:** The single most important predictor of a future suicide attempt is a **previous history of suicide attempts**. * **Demographics:** Men are more likely to **complete** suicide (using violent methods), while women are more likely to **attempt** suicide (often via poisoning/overdose). * **High-Risk Groups:** Elderly males, physicians (especially anesthesiologists and psychiatrists), and individuals with chronic painful illnesses are at higher risk. * **SAD PERSONS Scale:** A useful mnemonic to assess suicide risk (Sex, Age, Depression, Previous attempt, Ethanol, Rational thinking loss, Social support lacking, Organized plan, No spouse, Sickness).

Question 69: Which of the following medicines is associated with the side effect of sexual dysfunction?

A. Fluoxetine (Correct Answer)
B. Mianserin
C. Bupropion
D. None of the above

Explanation: **Explanation:** **Fluoxetine** is a Selective Serotonin Reuptake Inhibitor (SSRI). Sexual dysfunction is one of the most common and distressing side effects of SSRIs, occurring in approximately 30% to 60% of patients. The underlying mechanism involves the stimulation of **5-HT2 receptors** in the spinal cord and brain, which inhibits the spinal reflexes associated with orgasm and ejaculation, and decreases dopamine release in the reward centers, leading to reduced libido. **Analysis of Incorrect Options:** * **Mianserin:** This is a tetracyclic antidepressant (TeCA) that acts as an antagonist at H1, α1, α2, and 5-HT2 receptors. Because it blocks 5-HT2 receptors rather than increasing serotonin at those sites, it is generally associated with a much lower risk of sexual dysfunction compared to SSRIs. * **Bupropion:** This is a Norepinephrine-Dopamine Reuptake Inhibitor (NDRI). It does not affect the serotonergic system. In fact, it is often used as an "add-on" or alternative treatment to alleviate SSRI-induced sexual dysfunction because it enhances dopaminergic neurotransmission. **Clinical Pearls for NEET-PG:** * **Most common sexual side effects:** Delayed ejaculation and anorgasmia. * **Management:** If sexual dysfunction occurs, the clinician may consider a "drug holiday" (briefly stopping the drug over the weekend), switching to **Bupropion, Mirtazapine, or Nefazodone**, or adding **Sildenafil**. * **High-Yield Fact:** Among SSRIs, **Paroxetine** is often cited as having the highest incidence of sexual side effects.

Question 70: A 34-year-old housewife reports a three-month history of feeling low, lack of interest in activities, lethargy, multiple body aches, feelings of worthlessness, decreased appetite, and disturbed sleep with early morning awakening. She is likely to benefit from:

A. Anti-psychotics
B. Anti-depressants (Correct Answer)
C. Anxiolytics
D. Hypno-sedatives

Explanation: ### Explanation The clinical presentation described is a classic case of **Major Depressive Disorder (MDD)**. According to ICD-10 and DSM-5 criteria, the patient exhibits the core triad of depression along with somatic symptoms: 1. **Core Symptoms:** Low mood, anhedonia (lack of interest), and anergia (lethargy). 2. **Cognitive Symptoms:** Feelings of worthlessness. 3. **Biological/Somatic Symptoms:** Decreased appetite, multiple body aches, and **early morning awakening** (a hallmark of "melancholic" or endogenous depression). Since the symptoms have lasted for three months (exceeding the 2-week threshold), the primary treatment modality is **Anti-depressants** (Option B), such as SSRIs, which address the underlying neurotransmitter imbalances (primarily Serotonin and Norepinephrine). **Why other options are incorrect:** * **Anti-psychotics (A):** These are indicated for schizophrenia or mood disorders with psychotic features (e.g., delusions/hallucinations). This patient shows no signs of psychosis. * **Anxiolytics (C):** While they may help with comorbid anxiety, they do not treat the core depressive symptoms or feelings of worthlessness. * **Hypno-sedatives (D):** These are used for short-term management of insomnia. While this patient has disturbed sleep, treating the underlying depression with antidepressants will naturally restore the sleep cycle. **High-Yield Clinical Pearls for NEET-PG:** * **Early Morning Awakening:** This is the most specific sleep disturbance for endogenous depression (waking up at least 2 hours before the usual time). * **Somatic Symptoms:** In the Indian context, depression often presents with "masked" symptoms like multiple body aches or "gas" rather than a direct complaint of sadness. * **Treatment Duration:** Antidepressants typically take **2–4 weeks** to show a visible therapeutic effect. * **First-line:** SSRIs (e.g., Fluoxetine, Sertraline) are the first-line pharmacological choice due to their favorable safety profile.

Practice by Chapter

Major Depressive Disorder

Practice Questions

Bipolar Disorder: Manic Episodes

Practice Questions

Bipolar Disorder: Depressive and Mixed Episodes

Practice Questions

Persistent Depressive Disorder (Dysthymia)

Practice Questions

Cyclothymic Disorder

Practice Questions

Seasonal Affective Disorder

Practice Questions

Suicide and Suicidal Behavior

Practice Questions

Pharmacotherapy of Mood Disorders

Practice Questions

Psychotherapy for Mood Disorders

Practice Questions

Brain Stimulation Therapies

Practice Questions

Treatment-Resistant Depression

Practice Questions

Mood Disorders in Special Populations

Practice Questions

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